|
BEDSIDE COLONOSCOPY
|
Facility
|
IP
|
$3,462.00
|
|
| Hospital Charge Code |
76102540
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$450.06 |
| Max. Negotiated Rate |
$3,323.52 |
| Rate for Payer: Aetna Commercial |
$2,665.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,700.36
|
| Rate for Payer: Cash Price |
$1,731.00
|
| Rate for Payer: Cigna Commercial |
$2,873.46
|
| Rate for Payer: First Health Commercial |
$3,288.90
|
| Rate for Payer: Humana Commercial |
$2,942.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,838.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,554.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,038.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,046.56
|
| Rate for Payer: Ohio Health Group HMO |
$2,596.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$692.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$450.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,073.22
|
| Rate for Payer: PHCS Commercial |
$3,323.52
|
| Rate for Payer: United Healthcare All Payer |
$3,046.56
|
|
|
BEDSIDE COLONOSCOPY
|
Facility
|
OP
|
$3,462.00
|
|
| Hospital Charge Code |
76102540
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$450.06 |
| Max. Negotiated Rate |
$3,323.52 |
| Rate for Payer: Aetna Commercial |
$2,665.74
|
| Rate for Payer: Anthem Medicaid |
$1,190.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,700.36
|
| Rate for Payer: Cash Price |
$1,731.00
|
| Rate for Payer: Cigna Commercial |
$2,873.46
|
| Rate for Payer: First Health Commercial |
$3,288.90
|
| Rate for Payer: Humana Commercial |
$2,942.70
|
| Rate for Payer: Humana KY Medicaid |
$1,190.58
|
| Rate for Payer: Kentucky WC Medicaid |
$1,202.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,838.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,554.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,038.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,214.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,046.56
|
| Rate for Payer: Ohio Health Group HMO |
$2,596.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$692.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$450.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,073.22
|
| Rate for Payer: PHCS Commercial |
$3,323.52
|
| Rate for Payer: United Healthcare All Payer |
$3,046.56
|
|
|
BEDSIDE ECMO
|
Facility
|
IP
|
$8,202.00
|
|
| Hospital Charge Code |
76102541
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,066.26 |
| Max. Negotiated Rate |
$7,873.92 |
| Rate for Payer: Aetna Commercial |
$6,315.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,397.56
|
| Rate for Payer: Cash Price |
$4,101.00
|
| Rate for Payer: Cigna Commercial |
$6,807.66
|
| Rate for Payer: First Health Commercial |
$7,791.90
|
| Rate for Payer: Humana Commercial |
$6,971.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,725.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,053.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,460.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,217.76
|
| Rate for Payer: Ohio Health Group HMO |
$6,151.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,640.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,066.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,542.62
|
| Rate for Payer: PHCS Commercial |
$7,873.92
|
| Rate for Payer: United Healthcare All Payer |
$7,217.76
|
|
|
BEDSIDE ECMO
|
Facility
|
OP
|
$8,202.00
|
|
| Hospital Charge Code |
76102541
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,066.26 |
| Max. Negotiated Rate |
$7,873.92 |
| Rate for Payer: Aetna Commercial |
$6,315.54
|
| Rate for Payer: Anthem Medicaid |
$2,820.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,397.56
|
| Rate for Payer: Cash Price |
$4,101.00
|
| Rate for Payer: Cigna Commercial |
$6,807.66
|
| Rate for Payer: First Health Commercial |
$7,791.90
|
| Rate for Payer: Humana Commercial |
$6,971.70
|
| Rate for Payer: Humana KY Medicaid |
$2,820.67
|
| Rate for Payer: Kentucky WC Medicaid |
$2,849.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,725.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,053.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,460.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,877.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,217.76
|
| Rate for Payer: Ohio Health Group HMO |
$6,151.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,640.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,066.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,542.62
|
| Rate for Payer: PHCS Commercial |
$7,873.92
|
| Rate for Payer: United Healthcare All Payer |
$7,217.76
|
|
|
BEDSIDE EGD
|
Facility
|
OP
|
$3,009.00
|
|
| Hospital Charge Code |
76102539
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$391.17 |
| Max. Negotiated Rate |
$2,888.64 |
| Rate for Payer: Aetna Commercial |
$2,316.93
|
| Rate for Payer: Anthem Medicaid |
$1,034.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,347.02
|
| Rate for Payer: Cash Price |
$1,504.50
|
| Rate for Payer: Cigna Commercial |
$2,497.47
|
| Rate for Payer: First Health Commercial |
$2,858.55
|
| Rate for Payer: Humana Commercial |
$2,557.65
|
| Rate for Payer: Humana KY Medicaid |
$1,034.80
|
| Rate for Payer: Kentucky WC Medicaid |
$1,045.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,467.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,220.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$902.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,055.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,647.92
|
| Rate for Payer: Ohio Health Group HMO |
$2,256.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$601.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$391.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$932.79
|
| Rate for Payer: PHCS Commercial |
$2,888.64
|
| Rate for Payer: United Healthcare All Payer |
$2,647.92
|
|
|
BEDSIDE EGD
|
Facility
|
IP
|
$3,009.00
|
|
| Hospital Charge Code |
76102539
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$391.17 |
| Max. Negotiated Rate |
$2,888.64 |
| Rate for Payer: Aetna Commercial |
$2,316.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,347.02
|
| Rate for Payer: Cash Price |
$1,504.50
|
| Rate for Payer: Cigna Commercial |
$2,497.47
|
| Rate for Payer: First Health Commercial |
$2,858.55
|
| Rate for Payer: Humana Commercial |
$2,557.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,467.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,220.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$902.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,647.92
|
| Rate for Payer: Ohio Health Group HMO |
$2,256.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$601.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$391.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$932.79
|
| Rate for Payer: PHCS Commercial |
$2,888.64
|
| Rate for Payer: United Healthcare All Payer |
$2,647.92
|
|
|
BEDSIDE-SPIROMETRY/EACH
|
Facility
|
IP
|
$266.00
|
|
|
Service Code
|
HCPCS 94010
|
| Hospital Charge Code |
76102494
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$34.58 |
| Max. Negotiated Rate |
$255.36 |
| Rate for Payer: Aetna Commercial |
$204.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$207.48
|
| Rate for Payer: Cash Price |
$133.00
|
| Rate for Payer: Cigna Commercial |
$220.78
|
| Rate for Payer: First Health Commercial |
$252.70
|
| Rate for Payer: Humana Commercial |
$226.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$218.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$196.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$79.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$234.08
|
| Rate for Payer: Ohio Health Group HMO |
$199.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$53.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$34.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$82.46
|
| Rate for Payer: PHCS Commercial |
$255.36
|
| Rate for Payer: United Healthcare All Payer |
$234.08
|
|
|
BEDSIDE-SPIROMETRY/EACH
|
Facility
|
OP
|
$266.00
|
|
|
Service Code
|
HCPCS 94010
|
| Hospital Charge Code |
76102494
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$34.58 |
| Max. Negotiated Rate |
$255.36 |
| Rate for Payer: Aetna Commercial |
$204.82
|
| Rate for Payer: Anthem Medicaid |
$91.48
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$135.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$207.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$189.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$182.36
|
| Rate for Payer: Cash Price |
$133.00
|
| Rate for Payer: Cash Price |
$133.00
|
| Rate for Payer: Cigna Commercial |
$220.78
|
| Rate for Payer: First Health Commercial |
$252.70
|
| Rate for Payer: Humana Commercial |
$226.10
|
| Rate for Payer: Humana KY Medicaid |
$91.48
|
| Rate for Payer: Humana Medicare Advantage |
$135.08
|
| Rate for Payer: Kentucky WC Medicaid |
$92.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$218.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$196.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$162.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$93.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$234.08
|
| Rate for Payer: Ohio Health Group HMO |
$199.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$53.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$34.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$82.46
|
| Rate for Payer: PHCS Commercial |
$255.36
|
| Rate for Payer: United Healthcare All Payer |
$234.08
|
|
|
BEDSIDE-SPIROMETRY/EACH
|
Professional
|
Both
|
$266.00
|
|
|
Service Code
|
HCPCS 94010
|
| Hospital Charge Code |
76102494
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$10.58 |
| Max. Negotiated Rate |
$266.00 |
| Rate for Payer: Aetna Commercial |
$49.95
|
| Rate for Payer: Anthem Medicaid |
$24.44
|
| Rate for Payer: Buckeye Medicare Advantage |
$266.00
|
| Rate for Payer: Cash Price |
$133.00
|
| Rate for Payer: Cash Price |
$133.00
|
| Rate for Payer: Cigna Commercial |
$48.60
|
| Rate for Payer: Healthspan PPO |
$38.69
|
| Rate for Payer: Humana Medicaid |
$24.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$10.58
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$24.93
|
| Rate for Payer: Molina Healthcare Passport |
$24.44
|
| Rate for Payer: Multiplan PHCS |
$159.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$186.20
|
| Rate for Payer: UHCCP Medicaid |
$93.10
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$24.68
|
|
|
BEDSIDE-SPIROMETRY/EACH
|
Facility
|
IP
|
$218.00
|
|
|
Service Code
|
HCPCS 94010
|
| Hospital Charge Code |
46000001
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$28.34 |
| Max. Negotiated Rate |
$209.28 |
| Rate for Payer: Aetna Commercial |
$167.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$170.04
|
| Rate for Payer: Cash Price |
$109.00
|
| Rate for Payer: Cigna Commercial |
$180.94
|
| Rate for Payer: First Health Commercial |
$207.10
|
| Rate for Payer: Humana Commercial |
$185.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$178.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$160.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$65.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$191.84
|
| Rate for Payer: Ohio Health Group HMO |
$163.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$43.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$67.58
|
| Rate for Payer: PHCS Commercial |
$209.28
|
| Rate for Payer: United Healthcare All Payer |
$191.84
|
|
|
BEDSIDE-SPIROMETRY/EACH
|
Facility
|
OP
|
$218.00
|
|
|
Service Code
|
HCPCS 94010
|
| Hospital Charge Code |
46000001
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$28.34 |
| Max. Negotiated Rate |
$209.28 |
| Rate for Payer: Aetna Commercial |
$167.86
|
| Rate for Payer: Anthem Medicaid |
$74.97
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$135.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$170.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$189.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$182.36
|
| Rate for Payer: Cash Price |
$109.00
|
| Rate for Payer: Cash Price |
$109.00
|
| Rate for Payer: Cigna Commercial |
$180.94
|
| Rate for Payer: First Health Commercial |
$207.10
|
| Rate for Payer: Humana Commercial |
$185.30
|
| Rate for Payer: Humana KY Medicaid |
$74.97
|
| Rate for Payer: Humana Medicare Advantage |
$135.08
|
| Rate for Payer: Kentucky WC Medicaid |
$75.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$178.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$160.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$162.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$76.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$191.84
|
| Rate for Payer: Ohio Health Group HMO |
$163.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$43.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$67.58
|
| Rate for Payer: PHCS Commercial |
$209.28
|
| Rate for Payer: United Healthcare All Payer |
$191.84
|
|
|
BEDSIDE-SPIROMETRY/EACH(P
|
Professional
|
Both
|
$48.00
|
|
|
Service Code
|
HCPCS 94010
|
| Hospital Charge Code |
761P2494
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$10.58 |
| Max. Negotiated Rate |
$49.95 |
| Rate for Payer: Aetna Commercial |
$49.95
|
| Rate for Payer: Anthem Medicaid |
$24.44
|
| Rate for Payer: Buckeye Medicare Advantage |
$48.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna Commercial |
$48.60
|
| Rate for Payer: Healthspan PPO |
$38.69
|
| Rate for Payer: Humana Medicaid |
$24.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$10.58
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$24.93
|
| Rate for Payer: Molina Healthcare Passport |
$24.44
|
| Rate for Payer: Multiplan PHCS |
$28.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$33.60
|
| Rate for Payer: UHCCP Medicaid |
$16.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$24.68
|
|
|
BEDSIDE-SPIROMETRY/EACH(T
|
Facility
|
OP
|
$218.00
|
|
|
Service Code
|
HCPCS 94010
|
| Hospital Charge Code |
761T2494
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$28.34 |
| Max. Negotiated Rate |
$209.28 |
| Rate for Payer: Aetna Commercial |
$167.86
|
| Rate for Payer: Anthem Medicaid |
$74.97
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$135.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$170.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$189.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$182.36
|
| Rate for Payer: Cash Price |
$109.00
|
| Rate for Payer: Cash Price |
$109.00
|
| Rate for Payer: Cigna Commercial |
$180.94
|
| Rate for Payer: First Health Commercial |
$207.10
|
| Rate for Payer: Humana Commercial |
$185.30
|
| Rate for Payer: Humana KY Medicaid |
$74.97
|
| Rate for Payer: Humana Medicare Advantage |
$135.08
|
| Rate for Payer: Kentucky WC Medicaid |
$75.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$178.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$160.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$162.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$76.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$191.84
|
| Rate for Payer: Ohio Health Group HMO |
$163.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$43.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$67.58
|
| Rate for Payer: PHCS Commercial |
$209.28
|
| Rate for Payer: United Healthcare All Payer |
$191.84
|
|
|
BEDSIDE-SPIROMETRY/EACH(T
|
Facility
|
IP
|
$218.00
|
|
|
Service Code
|
HCPCS 94010
|
| Hospital Charge Code |
761T2494
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$28.34 |
| Max. Negotiated Rate |
$209.28 |
| Rate for Payer: Aetna Commercial |
$167.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$170.04
|
| Rate for Payer: Cash Price |
$109.00
|
| Rate for Payer: Cigna Commercial |
$180.94
|
| Rate for Payer: First Health Commercial |
$207.10
|
| Rate for Payer: Humana Commercial |
$185.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$178.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$160.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$65.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$191.84
|
| Rate for Payer: Ohio Health Group HMO |
$163.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$43.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$67.58
|
| Rate for Payer: PHCS Commercial |
$209.28
|
| Rate for Payer: United Healthcare All Payer |
$191.84
|
|
|
BEECH TREE IGE
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000728
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$62.40 |
| Rate for Payer: Aetna Commercial |
$50.05
|
| Rate for Payer: Anthem Medicaid |
$5.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.22
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cigna Commercial |
$53.95
|
| Rate for Payer: First Health Commercial |
$61.75
|
| Rate for Payer: Humana Commercial |
$55.25
|
| Rate for Payer: Humana KY Medicaid |
$5.22
|
| Rate for Payer: Humana Medicare Advantage |
$5.22
|
| Rate for Payer: Kentucky WC Medicaid |
$5.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$53.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$57.20
|
| Rate for Payer: Ohio Health Group HMO |
$48.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.15
|
| Rate for Payer: PHCS Commercial |
$62.40
|
| Rate for Payer: United Healthcare All Payer |
$57.20
|
|
|
BEECH TREE IGE
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000728
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.45 |
| Max. Negotiated Rate |
$62.40 |
| Rate for Payer: Aetna Commercial |
$50.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.20
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cigna Commercial |
$53.95
|
| Rate for Payer: First Health Commercial |
$61.75
|
| Rate for Payer: Humana Commercial |
$55.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$53.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$57.20
|
| Rate for Payer: Ohio Health Group HMO |
$48.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.15
|
| Rate for Payer: PHCS Commercial |
$62.40
|
| Rate for Payer: United Healthcare All Payer |
$57.20
|
|
|
BEHAVIORAL AND DEVELOPMENTAL DISORDERS
|
Facility
|
IP
|
$19,672.86
|
|
|
Service Code
|
MSDRG 886
|
| Min. Negotiated Rate |
$13,349.44 |
| Max. Negotiated Rate |
$19,672.86 |
| Rate for Payer: Anthem Medicaid |
$13,349.44
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$14,052.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$19,672.86
|
| Rate for Payer: CareSource Just4Me Medicare |
$18,970.25
|
| Rate for Payer: Humana KY Medicaid |
$13,349.44
|
| Rate for Payer: Humana Medicare Advantage |
$14,052.04
|
| Rate for Payer: Kentucky WC Medicaid |
$13,482.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$16,862.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,616.43
|
|
|
BEHAVIOR COUNSEL OBESITY 15 MI
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
HCPCS G0447
|
| Hospital Charge Code |
51000349
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$20.80 |
| Max. Negotiated Rate |
$153.60 |
| Rate for Payer: Aetna Commercial |
$123.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$124.80
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cigna Commercial |
$132.80
|
| Rate for Payer: First Health Commercial |
$152.00
|
| Rate for Payer: Humana Commercial |
$136.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$131.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$118.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$48.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$140.80
|
| Rate for Payer: Ohio Health Group HMO |
$120.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49.60
|
| Rate for Payer: PHCS Commercial |
$153.60
|
| Rate for Payer: United Healthcare All Payer |
$140.80
|
|
|
BEHAVIOR COUNSEL OBESITY 15 MI
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
HCPCS G0447
|
| Hospital Charge Code |
51000349
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$20.80 |
| Max. Negotiated Rate |
$153.60 |
| Rate for Payer: Aetna Commercial |
$123.20
|
| Rate for Payer: Anthem Medicaid |
$55.02
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$77.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$124.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$107.91
|
| Rate for Payer: CareSource Just4Me Medicare |
$104.06
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cigna Commercial |
$132.80
|
| Rate for Payer: First Health Commercial |
$152.00
|
| Rate for Payer: Humana Commercial |
$136.00
|
| Rate for Payer: Humana KY Medicaid |
$55.02
|
| Rate for Payer: Humana Medicare Advantage |
$77.08
|
| Rate for Payer: Kentucky WC Medicaid |
$55.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$131.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$118.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$92.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$56.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$140.80
|
| Rate for Payer: Ohio Health Group HMO |
$120.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49.60
|
| Rate for Payer: PHCS Commercial |
$153.60
|
| Rate for Payer: United Healthcare All Payer |
$140.80
|
|
|
BEHAVIOR COUNSEL OBESITY 15 MI
|
Professional
|
Both
|
$160.00
|
|
|
Service Code
|
HCPCS G0447
|
| Hospital Charge Code |
51000349
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$26.60 |
| Max. Negotiated Rate |
$160.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$160.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$26.60
|
| Rate for Payer: Multiplan PHCS |
$96.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$112.00
|
| Rate for Payer: UHCCP Medicaid |
$56.00
|
|
|
BEHAVIOR ID ASSMNT BY A PHYS
|
Professional
|
Both
|
$189.00
|
|
|
Service Code
|
HCPCS 97151
|
| Hospital Charge Code |
90000019
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$49.63 |
| Max. Negotiated Rate |
$189.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$189.00
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$49.63
|
| Rate for Payer: Multiplan PHCS |
$113.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$132.30
|
| Rate for Payer: UHCCP Medicaid |
$66.15
|
|
|
BEHAVIOR ID ASSMNT BY A PHYS
|
Facility
|
OP
|
$189.00
|
|
|
Service Code
|
HCPCS 97151
|
| Hospital Charge Code |
90000019
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$24.57 |
| Max. Negotiated Rate |
$181.44 |
| Rate for Payer: Aetna Commercial |
$145.53
|
| Rate for Payer: Anthem Medicaid |
$65.00
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$77.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$147.42
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$107.91
|
| Rate for Payer: CareSource Just4Me Medicare |
$104.06
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cigna Commercial |
$156.87
|
| Rate for Payer: First Health Commercial |
$179.55
|
| Rate for Payer: Humana Commercial |
$160.65
|
| Rate for Payer: Humana KY Medicaid |
$65.00
|
| Rate for Payer: Humana Medicare Advantage |
$77.08
|
| Rate for Payer: Kentucky WC Medicaid |
$65.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$154.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$139.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$92.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$66.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$166.32
|
| Rate for Payer: Ohio Health Group HMO |
$141.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$37.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$58.59
|
| Rate for Payer: PHCS Commercial |
$181.44
|
| Rate for Payer: United Healthcare All Payer |
$166.32
|
|
|
BEHAVIOR ID ASSMNT BY A PHYS
|
Facility
|
IP
|
$189.00
|
|
|
Service Code
|
HCPCS 97151
|
| Hospital Charge Code |
90000019
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$24.57 |
| Max. Negotiated Rate |
$181.44 |
| Rate for Payer: Aetna Commercial |
$145.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$147.42
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cigna Commercial |
$156.87
|
| Rate for Payer: First Health Commercial |
$179.55
|
| Rate for Payer: Humana Commercial |
$160.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$154.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$139.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$56.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$166.32
|
| Rate for Payer: Ohio Health Group HMO |
$141.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$37.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$58.59
|
| Rate for Payer: PHCS Commercial |
$181.44
|
| Rate for Payer: United Healthcare All Payer |
$166.32
|
|
|
BEHAVIOR ID ASSMNT BY A PHYS(P
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 97151
|
| Hospital Charge Code |
900P0019
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$49.63 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$150.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$49.63
|
| Rate for Payer: Multiplan PHCS |
$90.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$105.00
|
| Rate for Payer: UHCCP Medicaid |
$52.50
|
|
|
BEHAVIOR ID ASSMNT BY A PHYS(T
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
HCPCS 97151
|
| Hospital Charge Code |
900T0019
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$5.07 |
| Max. Negotiated Rate |
$107.91 |
| Rate for Payer: Aetna Commercial |
$30.03
|
| Rate for Payer: Anthem Medicaid |
$13.41
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$77.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30.42
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$107.91
|
| Rate for Payer: CareSource Just4Me Medicare |
$104.06
|
| Rate for Payer: Cash Price |
$19.50
|
| Rate for Payer: Cash Price |
$19.50
|
| Rate for Payer: Cigna Commercial |
$32.37
|
| Rate for Payer: First Health Commercial |
$37.05
|
| Rate for Payer: Humana Commercial |
$33.15
|
| Rate for Payer: Humana KY Medicaid |
$13.41
|
| Rate for Payer: Humana Medicare Advantage |
$77.08
|
| Rate for Payer: Kentucky WC Medicaid |
$13.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$92.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$13.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$34.32
|
| Rate for Payer: Ohio Health Group HMO |
$29.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12.09
|
| Rate for Payer: PHCS Commercial |
$37.44
|
| Rate for Payer: United Healthcare All Payer |
$34.32
|
|
